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Analysis of Individual-Participant Data from 19 Cohort Studies International Journal of Obesity (2020) 44:1368–1375 https://doi.org/10.1038/s41366-019-0480-3 ARTICLE Behaviour, Psychology and Sociology Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies 1,2 3 4,5 2 5,6,7 Marianna Virtanen ● Markus Jokela ● Tea Lallukka ● Linda Magnusson Hanson ● Jaana Pentti ● 5 8,9 10,11 12 13 13 Solja T. Nyberg ● Lars Alfredsson ● G. David Batty ● Annalisa Casini ● Els Clays ● Dirk DeBacquer ● 4,8 2,8,14 2,4 10 12 15 Jenni Ervasti ● Eleonor Fransson ● Jaana I. Halonen ● Jenny Head ● France Kittel ● Anders Knutsson ● 2 16 4 5 5 4,17 Constanze Leineweber ● Maria Nordin ● Tuula Oksanen ● Olli Pietiläinen ● Ossi Rahkonen ● Paula Salo ● 10,18 6,7 6,19,20 2 6,7 Archana Singh-Manoux ● Sari Stenholm ● Sakari B. Suominen ● Töres Theorell ● Jussi Vahtera ● 21 2 5,10 Peter Westerholm ● Hugo Westerlund ● Mika Kivimäki Received: 31 May 2019 / Revised: 1 October 2019 / Accepted: 27 October 2019 / Published online: 25 November 2019 © The Author(s) 2019. This article is published with open access Abstract Objective To examine the relation between long working hours and change in body mass index (BMI). Methods We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, n = 1234567890();,: 1234567890();,: US and Australia ( 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy- weight people who work long hours. Introduction working environments, the global ‘epidemic’ of obesity currently affects all age groups, all populations, and coun- Obesity is a modifiable risk factor for an array of health tries of all income levels [3, 4]. problems, including cardiovascular disease, type 2 diabetes, Psychosocial work environment may have a role in certain cancers and dementia that collectively contribute to weight control although little research has been published a substantial proportion of disease burden and death beyond perceived stress at work. Current evidence suggests worldwide [1, 2]. Resulting also from changes in living and a modest association between work stress and overweight or obesity, with limited support from longitudinal studies [5, 6]. Another work-related aspect, long working hours, Supplementary information The online version of this article (https:// may also contribute to weight gain, owing to extended doi.org/10.1038/s41366-019-0480-3) contains supplementary periods of sitting, reduced opportunities for exercise, material, which is available to authorised users. changes in eating habits leading to positive energy balance, * Marianna Virtanen and subsequently to weight gain. marianna.virtanen@uef.fi Previous studies suggest associations of long working Extended author information available on the last page of the article hours with increased incidence of cardiovascular disease Long working hours and change in body weight: analysis of individual-participant data from 19 cohort. 1369 and type 2 diabetes [7–9], for which obesity is also a major Germany: German Socioeconomic Panel Survey [35]; and risk factor [10, 11]. There are few prospective studies Australia: Household, Income, and Labour Dynamics in examining the link between long working hours and chan- Australia [36]. In addition, we included the Survey of ges in body weight, and the findings are inconsistent with Health, Ageing and Retirement in Europe [37], which positive [12–15], and null [16] associations reported. Fur- included data from multiple European countries (France, ther, one study found that long working hours may confer Germany, Finland, Sweden, Denmark, Slovenia, Cyprus, protection against gaining weight [17]. In addition to the Romania, Bulgaria, Greece, Czech Republic, Slovakia, paucity of evidence, studies in this field are typically Hungary, Estonia, Latvia, Lithuania, Poland, The Nether- insufficiently powered to examine weight gain amongst lands, Belgium, Luxembourg, Spain, Portugal, Italy, people who are previously not overweight. Switzerland, and Austria). Accordingly, with a large collaborative study of 19 In total, there were 122,078 participants for prospective cohorts from Europe, the US and Australia, we examined analyses who were at work and provided data on working the association between working hours and subsequent hours, sociodemographic characteristics and repeat mea- change in body mass index (BMI), including an analysis of surements of BMI. long working hours in relation to each stage of weight gain: from non-overweight to overweight or obesity, from over- Assessment of working hours weight to obesity. Long working hours may also be asso- ciated with lower probability of weight loss among those In all cohorts, information on working hours at baseline with obesity. For the first time to our knowledge, the size of was obtained from self-report. We used the previously this dataset allows to examine also this issue. used categorisation of weekly working hours: <35 (part time), 35–40 (reference group), 41–48, 49–54 and ≥55 h (long working hours) [38, 39]. In all these studies, working Materials and methods hours data were based on a continuous response, the only exception being HHS [31] where responses were based on Participants a pre-defined categorises (<30, 30–40, 41–50 and >50 h/ week). For the purposes of the present analyses, we treated We used data from 19 cohort studies (Supplementary in that study the category of 30–40 h/week as the reference Table 1) which were either taken from Individual- with <30 h/week corresponding to part time, 41–50 h/week Participant-Data Meta-analysis in Working Populations corresponding to the 41–48 h category in meta-analysis (IPD-Work) Consortium [18], or were available from one of and>50workinghourscorrespondingtothe≥55 h two digital repositories of research data (the Inter- category. University Consortium for Political and Social Research; http://www.icpsr.umich.edu/icpsrweb/ICPSR/) or the UK Assessment of body mass index (BMI) Data Service (http://ukdataservice.ac.uk/). The studies were chosen according to the availability of working hours and At baseline and follow-up, BMI (expressed as kg/m2) was BMI data in a prospective cohort design with the follow-up based on self-reported height and weight in all cohort stu- not exceeding 10 years. All studies have their own approval dies except Whitehall II and Belstress, in which height and from their relevant local or national ethics committee, and weight were measured directly during a standardised clin- all participants had given informed consent. ical examination. The following categories at baseline and Six cohort studies were from the UK: British Birth at follow-up were calculated: not overweight (BMI < 25.0); Cohort 1970 (BCS1970) [19], British Household Panel overweight (25.0–29.9); obese (30.0 or more). For those Survey [20], National Child Development Study [21], with obesity, we also determined whether they lost weight Whitehall II study [22], UK Household Longitudinal Study to non-obesity or had weight loss of >5% [40] between the [23], and English Longitudinal Study of Aging [24]; four baseline and follow-up. were from the US: Americans’ Changing Lives [25], Midlife in the United States [26], Health and Retirement Covariates Study [27], and National Longitudinal Survey of Youth [28]; three from Finland: Finnish Public Sector Study [29], All covariates were measured at the baseline and were Health and Social Support Study [30], and Helsinki Health typically either self-reported or register-based depending on Study (HHS) [31]; two from Sweden: Swedish Long- the study in question. Socioeconomic status was based on itudinal Occupational Survey of Health [32] and Work, occupational position, or educational qualification and was Lipids and Fibrinogen Norrland [33]; and one each from categorised as high, intermediate, and low. Health-related Belgium: Belgian Job Stress Project (Belstress) [34]; factors included pre-existing chronic somatic disease (e.g., 1370 M. Virtanen et al. cardiovascular disease, diabetes, asthma, rheumatoid Results arthritis), and psychological distress or depressive symp- toms. Smoking (current vs non-smoker) [41] and leisure- Of the 122,078 participants, 61,143 (50.1%) were without time physical activity (low vs intermediate/high) [42] were overweight or obesity at baseline; 42,965 (35.2%) had both self-reported. overweight and 17,970 (14.7%) had obesity. Of those without overweight/obesity, 31,703 (51.9%) worked stan- Statistical analyses dard 35–40 h a week, 10,568 (17.3%) worked 41–48 h, 3897 (6.4%) worked 49–54 h and 3947 (6.5%) worked We used a two-stage approach to the present meta-analysis 55 h or more.
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